Provider Demographics
NPI:1528131364
Name:DENTAL PROFESSIONALS OF MICHIGAN, P.C.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF MICHIGAN, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOLDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-519-1919
Mailing Address - Street 1:3415 LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5063
Mailing Address - Country:US
Mailing Address - Phone:248-519-1919
Mailing Address - Fax:248-519-1920
Practice Address - Street 1:3415 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5063
Practice Address - Country:US
Practice Address - Phone:248-519-1919
Practice Address - Fax:248-519-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty